HomeMy WebLinkAboutDemolition Permit 06-0168
CITY OF PRIOR LAKE
DEMOLITION PERMIT
Date Rec' d
(Please type ourint and sip at T ''''.,..)
ADDRESS
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PERMIT NO. Off. 0 I & ~
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ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION
PID2S, d8er. ()~5-. 0
OWNER
(Name) ~ c:...c \, r ..0 u... Nt '-I
(Address)
~OG Go u...,.J\' IL'/ TR A ; L
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(phone) qs-,;z-490- 80;)... 7
,) oILDA tV. (}1 N. <S 5:3 S- )-.
CONTRACTOR
(Company Name)
(Contact Name)
(Address)
S COli ~Uo-N -- 'I
KON Kc0D
(phone) 9:s- J-- 4-9 b - 80;;L 7
(Phone) q 5;;l - rJ. c; d- - d- 3 4-4 ~
INTERNATIONAL Bun.DING CODE lft,
Type of Construdion: I II ill IV V A B
Oc:cupancy G',,,,..,: A B E F HIM R S
Division: I 2 3 4 5
Rf MPCA NOJ..lL' .lCATION OF 1l'I.l&IT TO PEllru'AM A DEMOLITION
Use ofBu.ilding:
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I hereby certifY that I have furnished information on this application which is to the best of my knowledge true and ..vue.... I also certify that
I am the owner or authorized agent for the above-mentioned l'."l'......j and that all construction will conform to all existing state and local laws
and willl'.u.........J in a.....v.Jance with submitted plans.. I am aware that the building official can revoke this permit for just cause. Furthermore,
I hereby agree that the city officiaI:rs:r a 'gnee may enter upon the property to perform needed inspections.
~ \> l :<,-B-20o(o
"J Signa~ - Date
METRO (1tt:<:ES) SAC UNIT
DE.lr..ld~tlNA'n:ON
TI+f5 /-k:>mG /A..lt'-,- rr
fur ;?eP~_ ~/'- ~6S
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This is to certifY that the ~uest in the above applieation and accompanying documents is in accordance with the City ZAlning Ordinance and may r'- ...d as requested.
9r~.l!;~ 8/ ID Ll5Io
V 24 bour notice for all iDSpediOUS (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue, Prior Lake, Minnesota 55372
plication Becomes Your Demolition
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SpeciaJ Conditions, if any
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Site Restoration Proposal For Demolition
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4t-liVNESO~~
Applicant:
SC-o\'l C,Cv-...N~\..1 ~u..OI...,c... WOL\<..~
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Address:
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C-ov..N\f.-'-) ,(If\ \'- t,t\~\) jO(L\J~N
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Check boxes below:
')if.. Fill Excavation to grade
;8C Sod or seed all bare soils
:)Q Erosion control (see handout). Maintain erosion control until turf is established.
)Q Cap sewer below grade. * Mark location. Licensed contractor required.
)e{ Cap water below grade. * Mark location. Licensed contractor required.
';:8( Call City of Prior Lake Public Works Depa.d.ment {952.447.9898) for water meter
J. ~J.uova1.
~ Cap gas line. * (By gas company)
..,g Disconnect electric at meter. (By electric company)
CJ Pump and fill cesspool/septic tank. Certified contractor required.
CJ Abandon well. Certified contractor required. Existing well
~ Remove existing structure foundation and footings, materials, and debris. * *
';Iii( Provide dust control by following means:
li\ Water mist from a water supply (i.e. neighbors, water tank)
}J Enclosure
3. Other
Comments: (provide survey or draw site plan)
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*Capping of utilities must be inspected.
** Final inspection and approval of restored site required. Deposit will be returned after
apPJ.oved final inspection.
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Signarik)
3-08-o~
Date
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Minnesota
Pollution
Control
A.::......cy
Minnesota Pollution Control A2encv
Notification of Intent to Perform a Demolition,
Tvne of Notification: {I Orlfinal r I Amended r 1 Proiect Cancellation
,Demolition Contractor:
Name: Scott Countv Himwav Deot.
AdJ.......: 600 Countrv Trail East
Bnildin2 Information:
Buildin!!: Name:None
Address/Location:4021 Eau Claire Trail
City. State.. Zin:Prior Lake. MN 55372
City. State. Zin:Jordan. MN 55352-9339
Contact P ..,..~..:Ron Robb
Phone Numberls ):952-496-8027
Countv:Scott
Phone Numberls):Disconnected
AJz.e of Bide. (vears):30 Size of Bide. (so. iLl:
1869
Buildin2 Owner:
Name:Scott Countv
Address: Scott Countv Himwav Deot.
600 Countrv Trail East
City. State. Zio:Jordan. Mn 55352
Number of Floors Includine: Basement Levells):2 (4 level solin
Pre.o;ent Use of Bid!!:.: Vacant
Prior Use ofBldll.: Simde Familv Residence
Dates when demolition or intentional burninl
willB~ -,L6-of,} & End'3-..1-4-o{P
Phone Number{s):9S2-496-8364
Notifieation most be oostmarked or received ten om WORKING dayS
before demolition befin8. *See item #IS for emqeDcv demolitions.
Both Be2inninf and Endins: dates should be amended in I . ".D.I.!!
.!.leces5lll'V to reflect correut Droiect dates.
Contact nerson:W.R. Ronnin2
H there is >260 linear feet or >160 souare feet of Rqulated Asbestos-Containin~ MateriallRACM) in the buildin~
to be demolished.. it must be removed b., a licensed asbestos contractor prior to demolition. The State of MN-,
Notice of Intent to Perform an Asbestos Abatement Proiect must be used to notit,., for the asbestos removal.
Is nonfriable ACM oresent in the stnleture to be demolished ?
. IrYES comolete items 1-9. If NO comolete :w;.""s 3-9..
r 1 YES IX 1 NO
1. IF ACM wm be left in olaee for the demolition indicate the amount of Catelorv I and/or Cate20rv n nonfriable ACM left
in olaee.
Cate2. I
Linear Feet
Cate2.. II
Linear Feet.
&1uare Feet
Sauare Feet
Cubic Feet
Cubic Feet
Cate20rv I nonfriable ACM means asbestos-containinq nackin~
28Skets.. resilient floor coverinl!. and asnhalt roofinq nroducts
containin2 more than one ..... ~~::t asbestos.
*Ca( -..L".. J I nonfriable ACM is Dot allowed to remain in Drace.
for demolition if it is in DOOr condition.
~ate20rv II nontiiable ACM means an" material. excludin~
CatellOrv I nonfriable ACM.. containinv: more than one oercent
t\sbestos tbaL when drv. cannot be crumbled. oulverized. or
reduced to a oowder bv hand oressure.
.Catel!orv II nonuiable ACM is not allowed to remain in Dlac~
for demolition if it has a h~h orobabilitv of hecominf crumbled,
oulverized. or reduced to a oowder durint! demolition. transoort.
or disoosal. (ex Transite. cement. slate roofin.ll
2. Descriotion & Location of ACM remainins in olace (ineludine Ooor # and room #\:
INotifica'ion onnlent m Perfunn a Demolition funn Iw-sw4-21.doc\
Revised 09/02.
W:\WDRD\MPCA\4021 EauCIaireTrll>Ldo!<
3. ComDaDv and/or individual that conducted the bulldin, insoection and the Drocedure used to d . ~.J ,.ine the
oresence or absen~e uf ACM (ineludint! analvtic method): * Prior to demolition all bulldines must be insoected bv
an u. S. Environm..."." 1 Protection Aeencv ( EP A ) tuXredited insDector.
Liesch Assoc.. Inc: Anthony Olson (No. A 13347): EMSL Analvtical in accordance with EPAl600 R-93/116.
Ab.:.,~....".ent by Tecbtron EmrineerinSL Inc.
4. DeseriDtion ofDlanned demolition and the SDeeific method{s) that will be used:
Excavator and front end loader to load in tandem dumn trncks. Tam and haul to land fill.
5. If the demolition was ordered bv a pvernment q:enev. nlease identifv the Hencv and attach a CODV of the
order:
Name: Title: Authoritv:
Date of Order lMID/Y): Date Ordered to Bellin (M!D/Y):
* NotificatioD fO,L!D emerpnc:v ~Iitioa IIUISt be submitted as euIv as .-sible before demolitioD beIrins. but Dot later thaD the
foIIcnriaV workiDV do. A .....oIition is CDDSidered U eI8 "'1,'- tv ONLY whea the facilitv has been deemed structurallv unsound ami
ia ........ of iauai.-t .......-- If tile stnldllraIIv UDIOIIad buihti!ll is known to eoatJIia uv replated ACM or is susned:ed to contain
anv replated ACM.. sneciallI. , . . lures MUST be followed. If v_ are unaware of the soecial Drocedures. instrudio_. ...... .Jatious can
be obtaiaed bv eoatadiav the MPCA at tile adJ. .oJ. or ob_ number listed below.
6. DescriDtion of Drocedure to be foUowed ill the event that une:meeted RACM is found or Cat. n nonfriable
ACM becomes crumbled. Dulverized or reduced to DOwder:
If susoected RACM or Cat. II is observed. sel!l'e28te :m..L...:a1 ayoidin2 crushinl!.. crumblimz or Dulverizimz. cover contact
licensed insoectionlabatement ~u~c.etor for testin2 and. if aoq....... ;ate. lo.......... handlina and disnosition.
7. Demolition Waste TransD, . I.. ~s) Information: 8. Demolition Waste Disoosal Information:
Transoorter Name:Scott County Landfill Name:Dem Con Landfill
Tran....~..... Contact:Ron Robb Owner/O~ .......:.u.r:Mark PahllJason Haus
Transnorter Address:600 Country Trail East AddresslLocation:13020 Dem Con Drive
City. State. Zin:Jordan. MN 55352 City. State. Zin:Shakonee. MN 55379
Phone Number: 952-496-8027 Phone Numbcr:952-445-5755
9. I certify that the above information is,...,.... ~t and I am a bonafide reDresentative of the demotition contractor
or buildiB2 owner and bve auth. oritv to ente. r into (i. .~ments for mv emDlover.
~ - ..-
Si2llature of C~..:......ctor/Owner \. -Q ~ ~ Date 1-0 9 " c) b
Send to: Minnesota Pollution ConW( A2enCY Fo'; auestions call:
Resrlonal Enyironmenuil Mamurement Division 651-296-6300
520 Lafayette Road North 1-800-657-3864
S1. PauL MN 55155-4194 FAX: 651-215-1593
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PCB Removal Information Polvchlorinated biDhenvls (PCBs) must be removed /Tom the buildinf! orior to demolition. PCBs may
be found in light ballasts. small CQDQcitors found in old ooDliances. and tramformer oils. For auestions call the MPCA Hazardous
Waste (l/W) business assistance unit at 1-800-646-6247.
M.. .' ~ :.rv Removal Information Mercurv containing material must be removed from the building orior to demolition. Mereurv
conlaininv materials mav include fluorescent. metal halide. high Dl'essure sodium. neon. mercurv'Vooor lamos. mercurv switches.
thermostat orohes. manom"...,,,-,... and f!af!es. For auestions call the MPCA HW business assistance unit at 1-800-646-6247.
Ref'ri.....,..,.ntslCFCsIHCFCS Recoverv Information A....... ..:r.ed technician must recover r,,,.f. :...,,-, l.UIU from r.,.1i ;...eration
eouiDment and n...,,-,...s in the buildinv Drior to demolition. For auestions coIL the CFC .... '''f' ,...... at 1-800-646-6247.
Lead Paint Insoection and Removal Anv loose lJDint on a structure must be analvzed to determine if it is lead based Daint. Anv
loose (f1a1rinv. chimi.l1& crumhlinv.) lead based 1J!liI!t on a strufipue must .be scrooed off and disDosed of DrolJeTlv. Lead based Daint
adhered to the substrate mav be disDOSed of as general demolition debris. For auestions call the Lead Dro.... ,..... at 1-800-646-6247.
rNotifL..,.,. , nflntrm In 1'.1, aDrmolition furm (w-sw4-2Ldoc\
Revised 05104
W:\WORD\MPCA\402IF..auClaireTd~